Approximately 1.2 billion U.S. dollars was recovered by the Medicaid Fraud Control Units (MFCUs) in 2023, roughly 71 percent of which came through criminal recoveries. The remaining 29 percent was recovered through civil convictions. With the unit's expenditure at 369 million U.S. dollars, this resulted in the MFCU recovering 3.35 dollars for every one dollar spent.
Civil recoveries surpass one billion U.S. dollars
Medicaid fraud is a widespread problem in the United States, and the role of the MFCUs is vitally important in combatting the exploitation of the program – criminal cases opened by MFCUs led to around 1,143 convictions in 2023. Criminal recoveries totaled 272 million U.S. dollars in 2023 – much lower than the previous year. While civil recoveries increased by nearly half a billion U.S. dollars between 2022 and 2023.
Types of fraud and abuse cases
MFCUs investigate fraud and patient abuse or neglect in nursing homes and care facilities. If there is a legitimate claim, MFCUs may file a criminal prosecution, a civil file, or even both. Fraud cases involve wrongdoings such as tax evasion, false claims, or billing for services that were never provided. Examples of patient abuse or neglect include a provider failing to supply the most basic of care or finding evidence of inadequate patient supervision. The continued success of the MFCUs can act as a major deterrent in the fight against Medicaid fraud and abuse.
Recoveries and expenditures regarding fraud cases under Medicaid in FY 2023, by type (in million U.S. dollars)*
* Including fraud, abuse, and neglect cases.
Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections. Recoveries may involve cases that include participation by other Federal and State agencies.
“Global” recoveries derive from civil settlements or judgments involving the U.S. Department of Justice and a group of State MFCUs and are facilitated by the National Association of Medicaid Fraud Control Units.
MFCU and Medicaid Expenditures include both State and Federal expenditures.
MFCU = Medicaid Fraud Control Units.
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US Department of Health and Human Services, & Office of Inspector General. (March 14, 2024). Recoveries and expenditures regarding fraud cases under Medicaid in FY 2023, by type (in million U.S. dollars)* [Graph]. In Statista. Retrieved October 30, 2024, from https://www.statista.com/statistics/716114/recoveries-and-expenditures-regarding-medicaid-fraud-cases/
US Department of Health and Human Services, und Office of Inspector General. "Recoveries and expenditures regarding fraud cases under Medicaid in FY 2023, by type (in million U.S. dollars)*." Chart. March 14, 2024. Statista. Accessed October 30, 2024. https://www.statista.com/statistics/716114/recoveries-and-expenditures-regarding-medicaid-fraud-cases/
US Department of Health and Human Services, Office of Inspector General. (2024). Recoveries and expenditures regarding fraud cases under Medicaid in FY 2023, by type (in million U.S. dollars)*. Statista. Statista Inc.. Accessed: October 30, 2024. https://www.statista.com/statistics/716114/recoveries-and-expenditures-regarding-medicaid-fraud-cases/
US Department of Health and Human Services, and Office of Inspector General. "Recoveries and Expenditures regarding Fraud Cases under Medicaid in Fy 2023, by Type (in Million U.S. Dollars)*." Statista, Statista Inc., 14 Mar 2024, https://www.statista.com/statistics/716114/recoveries-and-expenditures-regarding-medicaid-fraud-cases/
US Department of Health and Human Services & Office of Inspector General, Recoveries and expenditures regarding fraud cases under Medicaid in FY 2023, by type (in million U.S. dollars)* Statista, https://www.statista.com/statistics/716114/recoveries-and-expenditures-regarding-medicaid-fraud-cases/ (last visited October 30, 2024)
Recoveries and expenditures regarding fraud cases under Medicaid in FY 2023, by type (in million U.S. dollars)* [Graph], US Department of Health and Human Services, & Office of Inspector General, March 14, 2024. [Online]. Available: https://www.statista.com/statistics/716114/recoveries-and-expenditures-regarding-medicaid-fraud-cases/